Women are the most rapidly growing group of individuals infected with HIV. However, little is known about the mental health, neuroendocrine and immune consequences of HIV-infection in women. New findings from the applicants' longitudinal studies of non-urban HIV-infected gay men confirmed the hypotheses that stress influences not only immunity but also early disease progression, increasing the odds of developing HIV disease progression in men by nearly four-fold. Thus, the major objective of the proposed longitudinal study in HIV-infected women is to determine the effects of life event stress, depression, and HPA axis activity on immunity and disease progression. Studies will be conducted in North Florida were the majority of HIV-infected women are rural African-American women who have acquired the virus through heterosexual transmission, and where AIDS is the leading cause of death among non-white females (ages of 15-44 years). The Specific Aims of the proposed studies will test the hypotheses: 1) that stress and associated depressive symptoms are predictive co-factors of disease progression in HIV-infected women; 2) that severe life stress and associated depressive symptoms are predictive cofactors of cellular immune deficits over time in HIV-infected women; 3) that psychosocial factors (e.g. social support and coping) interact with stressful life events and depression to modify immune status and HIV disease progression, and; 4) that stress-related changes in immunity and disease progression are mediated, in part, by the HPA axis. In addition, these studies will provide among the first longitudinal data of the effects of HIV infection on neuropsychiatric, neuropsychological, endocrine, and immune parameters in women. These data may also identify characteristics of HIV infection which may be unique to women. Insights gained could lead to the design of interventions tailored to gender. The applicants believe that the proposed studies of rural HIV-infected minority women are both critical and timely, holding significant promise in identifying salient psychosocial factors which may impact on qualify of life, HIV-disease progression and ultimately survival in women.